SACRAMENTO — Two dueling groups combined their proposed ballot measures Tuesday into one that would slap a $2.60 tax on a $4 pack of cigarettes to aid health care — but officials said the 300 percent tax hike also would turn California into a gold mine for terrorists.

The California Hospital Association and anti-smoking groups, eyeing the November ballot, said the good far outweighs cigarette-smuggling concerns. It would provide nearly $2.3 billion annually for emergency rooms, children’s health insurance and nursing education.

But in an acknowledgment of the cigarette-smuggling problem, the measure would also set aside $20 million a year for law enforcement efforts.

Federal and state officials already are waging an uphill battle against cigarette smuggling from low-tax states to high-tax states, where the cigarettes are sold at a discount.

Many of the illegal operations are now tied to terrorism.

“Because of the immense profits in the illicit cigarette trade, as well as the potentially low penalties for getting caught, illicit cigarette trafficking now rivals drug trafficking as the method of choice to fill the bank accounts of terrorists,” said William Billingslea of the federal Bureau of Alcohol, Tobacco, Firearms and Explosives.

With existing California cigarettes taxes pushing $1 a pack, the state adopted new laws two years ago to fight the problem.

“Although this was an important first start, more work remains to be done to ensure all tobacco sales are legitimate and all appropriate taxes are paid,” said Assemblyman Jerome Horton, D-Inglewood.

Earlier this year, California Attorney General Bill Lockyer and nine other states’ top prosecutors joined forces with federal law enforcement agencies and major credit card firms in the fight against illegal Internet cigarette trafficking.

But making California’s combined taxes of $3.47 on a pack of cigarettes — the highest in the nation — would overwhelm California with black market sales, officials said.

“Diverse state tobacco taxes are a key reason for cigarette smuggling, in which organized crime and terrorist groups are increasingly involved,” said Bruce Bartlett of the National Center for Policy Analysis in Washington, D.C.

Radley Balko of the Cato Institute in the nation’s capital said New York’s black market “has aided a bevy of international terrorist organizations and nefarious elements, including the Russian mafia, Chinatown gangs, the Irish Republican Army, Hezbollah and al-Qaida.”

In 2002, Hezbollah ringleader Mohammad Youssef Hammoud was arrested in Charlotte, N.C., for operating a cigarette-smuggling ring that bought low-tax cigarettes in North Carolina and sold them on the black market in high-tax Michigan, Balko said.

Federal officials said a smuggler transporting cigarettes can typically make about $2 million on a single truckload of cigarettes.

The proposed health care initiative was unveiled at a news conference by representatives of two competing tobacco tax measures.

“This initiative offers Californians the best way to help tackle key elements of our growing health care crisis,” said Jim Knox of the American Cancer Society.

One campaign was led by the California Hospital Association and the other by the American Cancer Society.

The new campaign includes those organizations, plus the American Lung Association of California, California Emergency Nurses Association, American Heart Association, Children Now, the California Association of Physician Groups and the Campaign for Tobacco Free Kids, among others.

Because the extra per-pack tax would be expected to curb sales, the initiative also allots $159 million a year to offset any loss of revenue to Proposition 10 programs. Proposition 10 added a tax of 50 cents per pack to fund early childhood education.

(Click here if you are unable to view this photo gallery on your mobile device) The Ruth Bancroft Garden in Walnut Creek celebrates the life of its founder Ruth Bancroft who died at 109 on November 26, 2017. The Ruth Bancroft Garden is a nonprofit public dry garden that was planted by Mrs. Ruth Bancroft in 1972 and was opened to the...